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What Type of Exercise Is Best For Improving Insulin Sensitivity?

Although most all exercise is beneficial for improving your health, is there one form of exercise that trumps all others in helping to stabilize blood sugar levels and improve insulin sensitivity? In today’s post I want to discuss this topic and share with you my thoughts based on personal experience and research.

Before we dive right in, I want to be perfectly clear with a few things up front. When I find a particular methodology with fitness training to provide a positive result and then I make reference of what I found, it doesn’t mean the science is settled and the case is closed. For crying out loud, haven’t we had enough of that lately? Take the information for what it’s worth and do your own experimentation and evaluation of the research associated with it.

I want to clarify this in attempts to avoid the senseless debates that sometimes come up. There are a lot of people, so called “experts” included, that have very rigid positions on matters involving exercise and nutritional science. A lot of times this is clearly done to sell products or services (follow the money) and I get that. Those with a particular ideology will often fervently declare their way as being “the way.” This is not an attempt to do anything of the such.

Let me be clear in saying that I’m not looking to endorse anything in this article and there’s no affiliate links that I’ll make money on. If there’s anything I’m endorsing, it’s healthy eating and regular exercise, however you go about it. Now granted, I am in the personal fitness training industry and do provide services to help individuals who would like coaching and instruction in these areas, but this is different, and I’ll be upfront with that endorsement.

Alright, on to the subject of insulin sensitivity and if there is a form of exercise that actually works best to help improve it.

My hunch has always been that just about any exercise outside of the extreme would help improve insulin sensitivity because even the lowest intensity exercise has been shown to help reduce inflammation.

You may have heard me discuss this in the past, the idea of inflammation really being at the root cause behind the majority of health issues, insulin resistance included. There are lifestyle choices that lead to imbalances in the body, but ultimately it’s the resulting inflammation and cellular degeneration from them that trigger a downward spiral with the endocrine system.

Contrary to what some may believe, I can see how even low intensity exercise, like yoga for example, could be beneficial with helping to improving insulin sensitivity even though there’s little cardiorespiratory work being done. Any exercise that improves oxygen delivery, works the neuromuscular system, and helps move lymph fluid is likely to be beneficial on some level.

Having said that, is low intensity exercise the best way to improve insulin sensitivity? Or how about high intensity exercise? Should you focus on just aerobic exercise, or just resistance training?

Well let’s keep digging in…

First let’s look at high intensity interval training and/or the resistance training variety I often refer to as burst training. This is a form of exercise that generally equates to doing short periods of high intensity effort, followed by brief recovery periods. What’s interesting is research over the past twenty years or so on this subject has revealed some things about this type of training we previously didn’t know.

One of the biggest problems with high intensity interval training has always been getting the individual to work at a high enough intensity. The real benefit from this type of training is derived when the central nervous system is put under a significant overload stimulus with all-out effort. In short, interval training done “lolly-gagging” or “perceivably somewhat hard” doesn’t do jack.

This creates some dilemmas in the real world. For starters, not everyone is willing to work that hard and really push themselves. Make no mistakes about it, doing high intensity interval training correctly is going to kick your butt. There may be some benefits, but it’s never going to be pitched as an “easy” solution.

And then we have the issue of diminished returns with too much high intensity exercise. Look, a lot of this talk about benefits depends on individual who is training and how much of it is being done. A youth track athlete is not going to be in the same ballpark as a deconditioned individual over 40 when it comes to exercise prescription for interval training.

One of the dirty little secrets with too much high intensity exercise is the creation of free radicals, lactic acid, and other byproducts that can harm mitochondria following prolonged bouts of all out effort. That’s not even to mention the joint demands, recovery issues, soft tissue injuries, etc, with older individuals.

In short, high intensity interval training, while in small doses can certainly be beneficial, it’s not going to be the holy grail for middle age and older adults seeking to improve insulin sensitivity because of the limitations.  

However, it appears that a little bit of high intensity exercise isn’t a bad thing either.

What caught my attention in this one particular research study involving interval training I read (published in the Journal Of Physiology, 2012 Jan) was the level of intensity used.

Exercisers were separated into groups where they completed short 60 second cycling intervals repeated 10 times for a 20 minute total workout.  The two groups included one with sedentary, but generally healthy middle-age adults, and the other with individuals of a similar age but who had been diagnosed with cardiovascular disease.

The intervals for the second group (the one with individuals who had been diagnosed with cardiovascular disease) were modified so the participants would go to no more than 90 percent of their maximum heart rate during effort phases.

After several weeks on the program, both groups showed significant improvements in their health and fitness. Most remarkably though, the cardiac patients showed "significant improvements" in both heart and blood vessel functioning. Contrary to what some might have speculated, the intense exercise did not cause any heart problems for the cardiac patients. The belief is that the short duration of the intervals helped insulate the heart from the intensity.

Well, what about low intensity aerobic exercise like walking?

A cardiologist will tell you straight up that aerobic exercise is one of the best forms of exercise for your heart. I certainly don’t disagree with that sentiment and if I were recommending exercise prescription for someone with diabetes or heart disease, I’d start out them out with several weeks of low intensity aerobic exercise at 50-60% max heart rate.

So where does all this information lead us in terms of exercise prescription for improving insulin sensitivity?

Well, the traditional advice of performing ONLY low-intensity aerobic exercise for deconditioned individuals or those with cardiovascular and/or blood sugar issues (including insulin resistance) should at least be reconsidered based on the evidence of benefits with interval training.

Now I’d say it’s certainly not advisable for these individuals to run out and start doing P90X, Orange Theory, or some form of higher intensity interval exercise. However, with supervision and planned progression they could certainly benefit from eventually doing some small amounts of short bursts with higher intensity exercise.

How about if we just did resistance training instead? Again, while there are studies confirming the benefits of resistance training in helping to improve insulin sensitivity, I don’t believe this would be the optimal solution either in most cases due to the lack of cardiorespiratory work involved.

So we’re kind of at a point where we have some benefits with all these types of exercise, but since they work in different ways, use different energy systems, etc, they’re going to all have certain advantages and limitations.

No clear-cut winner as the best option for helping to improve insulin sensitivity, yet. We’ll we could combine these different types of exercise and create a balanced program where we do frequent aerobic work, some strength and resistance work 2-3 times per week, and some small amounts of high intensity interval work.

This is going to produce across the board benefits in health and fitness and would go a long way towards improving insulin sensitivity for sure. For many individuals this would be an ideal prescription.

But hold up, we do have another option. An option you may not have heard of yet.

Have you ever heard of “A+A” training? It’s an acronym for “alactic plus aerobic” training, a term made up by Al Ciampa of StrongFirst. It basically describes a type of training that emphasizes the alactic and aerobic energy systems at the expense of the glycolytic system. What the heck is all that you say?

In simple terms, it’s exercise that involves working your muscles with strength movements in an explosive manner, emphasizing power, which in turn conditions your entire body while elevating heart rate, but with less oxidative damage to the cells compared to doing repeat high intensity exercise.

But unlike with Crossfit, high intensity interval training, or some other “metcon” you won’t be doing grinding it out to the point where you’re getting gassed. Instead, you’d work until you reach an elevated heart rate (getting out of the zone where you could carry on a normal conversation) and then rest until your heart rate came back down and repeating. You never get very high and you don’t go too low during recovery periods to lose the aerobic benefits.

At the end of a workout, you’ll know you’ve trained but won’t need someone to pick you up off the floor. :)

You can learn more about this method of training by checking out an article by Pavel Tsatsouline at StrongFirst entitled “The Best All-Around Training Method Ever.”

While the title for his article is certainly debatable, depending on what “best” was referring to, I do believe the concept is worth looking into and exploring.

I’ll be writing more about it in future blog posts.

I could see a mix of training methods that include all of the above as being quite possibly “the best exercise prescription for improving insulin sensitivity” not to mention for improving body composition and fitness for the middle age and older adult.

If you’d like to learn more about how I could help you with a fitness routine or workout program design, please don’t hesitate to drop me a line.

Physiological adaptations to low-volume, high-intensity interval training in health and disease, The Journal of Physiology, 2012 Jan 30. [Epub ahead of print]

Physiological adaptations to low-volume, high-intensity interval training in health and disease, The Journal of Physiology, 2012 Jan 30. [Epub ahead of print]

Similar metabolic adaptations during exercise after low volume sprint interval and traditional endurance training in humans, Journal of Physiology, 2008 Jan 1;586(1):151-60

Low-volume interval training improves muscle oxidative capacity in sedentary adults, Medicine and Science in Sports and Exercise, 2011 Oct;43(10):1849-56

Acute high-intensity interval exercise reduces the postprandial glucose response and prevalence of hyperglycaemia in patients with type 2 diabetes, Diabetes, Obesity and Metabolism, 2012 Jan 23 [Epub ahead of print]

Shane Doll CPT, CSCS is a fitness professional and expert on exercise and body transformation for middle age and mature adults. He seeks to make a difference in the lives of others by providing instruction and coaching with a servant-based attitude. Since 2004 his Charleston personal training programs have helped over 3,000 Lowcountry residents.


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